Difference between revisions of "Tracheal injury"

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==Background==
 
==Background==
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[[File:Blausen 0865 TracheaAnatomy.png|thumb|Tracheal anatomy.]]
 
*Usually occurs at junction of trachea and cricoid cartilage
 
*Usually occurs at junction of trachea and cricoid cartilage
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*Direct trauma to airway is rare due to protection by sternum and mandible
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*Associated with [[cervical spine injury]], [[head injury]], multisystem trauma
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 +
===Common causes===
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*Motor vehicle accident: extended neck impacts on steering wheel or dashboard
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*"Clothes line injury", assaults/strangulation
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*Penetrating trauma (usually stabbings or gunshot wounds)
  
 
==Clinical Features==
 
==Clinical Features==
*Subcutaneous emphysema, stridor
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*[[Respiratory distress]]
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*Hoarseness, [[dysphonia]], [[cough]], [[stridor]], [[dysphagia]]
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*Subcutaneous emphysema
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*Cervical ecchymosis
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*[[Hemoptysis]]
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*Tracheal deviation or abnormal laryngeal contour
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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==Evaluation==
 
==Evaluation==
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''Investigate only once airway secure''
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*Plain films, CT
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**Air in soft tissues
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**[[Pneumomediastinum]], [[pneumothorax]]
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**[[cervical spine fractures and dislocations|Cervical spine fractures]]
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**Hematomas, cartilage fractures
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**Evaluate for other injuries
  
 
==Management==
 
==Management==
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===While preparing to secure airway===
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*Mobilize specialists/back-up (ENT, cardiothoracics, surgery, anesthesia)
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*Keep patient breathing spontaneously for as long as possible
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*High-flow [[O2]]
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*May by time with nebulized [[epinephrine]] and IV [[dexamethasone]]
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*Anti-reflux medications (e.g. [[ranitidine]], [[metoclopramide]])
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*[[Glycopyrrolate]] to reduce secretions
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===''AIRWAY MANAGEMENT''===
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''Avoid cricoid pressure!''
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*Awake fiberoptic intubation
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*Awake direct laryngoscopy/[[intubation]]
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*Inhalational induction/intubation (keep patient breathing spontaneously)
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*Awake tracheostomy
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*Consider intubating through open wound if transected trachea visible
  
 
==Disposition==
 
==Disposition==
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*Admit
  
 
==See Also==
 
==See Also==

Latest revision as of 13:48, 10 April 2021

Background

Tracheal anatomy.
  • Usually occurs at junction of trachea and cricoid cartilage
  • Direct trauma to airway is rare due to protection by sternum and mandible
  • Associated with cervical spine injury, head injury, multisystem trauma

Common causes

  • Motor vehicle accident: extended neck impacts on steering wheel or dashboard
  • "Clothes line injury", assaults/strangulation
  • Penetrating trauma (usually stabbings or gunshot wounds)

Clinical Features

Differential Diagnosis

Thoracic Trauma

Evaluation

Investigate only once airway secure

Management

While preparing to secure airway

AIRWAY MANAGEMENT

Avoid cricoid pressure!

  • Awake fiberoptic intubation
  • Awake direct laryngoscopy/intubation
  • Inhalational induction/intubation (keep patient breathing spontaneously)
  • Awake tracheostomy
  • Consider intubating through open wound if transected trachea visible

Disposition

  • Admit

See Also

External Links

References